The article reports on the studies which examine the contextual barriers to lifestyle physical activity interventions in Hong Kong, China. According to the authors of the study, pedestrians on a mass transit escalator system and in an air conditioned shopping mall were encouraged to take the stairs for their cardiovascular health by point-of-choice prompts. The results of the study showed that the active transport of walking on the mass transit system was reduced at higher rates of humidity and temperature, with steeper slopes for the effects of climate variables in men than in women.

This study used observational methods to examine physical activity (PA) and selected correlates in 28 parks in Tampa, Florida, and Chicago, Illinois. We observed 9,454 park users within predetermined activity zones and coded their activity as sedentary, walking (i.e., moderate intensity), or vigorous PA. In Tampa, higher temperature, unorganized activity, lower amounts of shade, lower neighborhood income, Hispanic neighborhood ethnicity, male gender and child age group were significantly associated with walking. Vigorous activity was not associated with income and ethnicity. Morning hours, unorganized activity, lower neighborhood income and African American neighborhood ethnicity were associated with walking in Chicago. Vigorous activity was associated with children, lower neighborhood income and African American ethnicity. Findings from this study can inform policy decisions and future research directions.

Background: Systematic study of human behavior in public parks and specific activity settings can inform policy to promote physical activity in diverse communities. Methods: Direct observation was used to assess physical activity in public parks in Tampa FL (n= 10) and Chicago IL (n= 18). Parks were selected from census tracts with high concentrations of white, African-American, and Hispanic populations. Representation from low- and high-income census tracts was also achieved. Physical activity was measured by a modified version of the System for Observing Play and Leisure Activity in Youth (SOPLAY). Activity codes from SOPLAY were transformed to energy expenditure per person (kcal/kg/min). Results: Seventy percent of Tampa and 51% of Chicago park users were observed engaged in sedentary behavior. In both cities, children were more likely than adults to be observed in walking or vigorous activity. In Tampa, parks located in neighborhoods with the highest concentration of Hispanic residents were associated with greatest levels of energy expenditure. In Chicago, parks in neighborhoods with the highest concentration of African Americans showed the highest energy expenditure per person. Gender was associated with physical activity only in Tampa parks. Energy expenditure also varied by activity areas. Conclusions: More than one half of park users in both cities engaged in sedentary behavior. While differences in park-based physical activity by neighborhood income and racial/ethnic composition were observed, these differences can more likely be attributed to the types of designated activity areas that support physical activity. The study findings suggest that specific configurations of park environments can enhance physical activity in parks.

Objective. Females are substantially less likely than males to cycle for transport in countries with low bicycle transport mode share. We investigated whether female commuter cyclists were more likely to use bicycle routes that provide separation from motor vehicle traffic. Methods. Census of cyclists observed at 15 locations (including off-road bicycle paths, on-road lanes and roads with no bicycle facilities) within a 7.4 kin radius of the central business district (CBD) of Melbourne, Australia, during peak commuting times in February 2004. Results. 6589 cyclists were observed, comprising 5229 males (79.4%) and 1360 females (20.6%). After adjustment for distance of the bicycle facility from the CBD, females showed a preference for using off-road paths rather than roads with no bicycle facilities (odds ratio [OR]=1.43, 95% confidence interval [CI]: 1.12, 1.83), or roads with on-road bicycle lanes (OR=1.34, 95% CI: 1.03, 1.75). Conclusions. Consistent with gender differences in risk aversion, female commuter cyclists preferred to use routes with maximum separation from motorized traffic. Improved cycling infrastructure in the form of bicycle paths and lanes that provide a high degree of separation from motor traffic is likely to be important for increasing transportation cycling amongst under-represented population groups such as women.

OBJECTIVE: Recent data suggest that residential environment may influence health behaviors and outcomes. We assessed whether perception of neighborhood problems was associated with diabetes behaviors and outcomes. RESEARCH DESIGN AND METHODS: This cross-sectional analysis included 7,830 diabetic adults enrolled in Translating Research Into Action for Diabetes, a study of diabetes care and outcomes in managed care settings. Perception of neighborhood problems was measured using a summary score of participants' ratings of crime, trash, litter, lighting at night, and access to exercise facilities, transportation, and supermarkets. Outcomes included health behaviors and clinical outcomes. Hierarchical regression models were used to account for clustering of patients within neighborhoods and to adjust for objective neighborhood socioeconomic status (percentage living in poverty) and potential individual-level confounders (age, sex, race/ethnicity, education, income, comorbidity index, and duration of diabetes). RESULTS: After adjustment, residents of neighborhoods in the lowest tertile (most perceived problems) reported higher rates of current smoking (15 vs. 11%) than those in the highest tertile and had slightly lower participation in any weekly physical activity (95 vs. 96%). In addition, their blood pressure control was worse (25 vs. 31% <130/80 mmHg), and their Short Form 12 scores were slightly lower (44 vs. 46 units for emotional well-being and 43 vs. 44 units for physical well-being); all P < 0.01. CONCLUSIONS: Neighborhood problems were most strongly associated with more smoking and higher blood pressure, both of which have significant implications for cardiovascular risk. Potential mechanisms that explain these associations should be further explored in longitudinal studies.

This paper examines the association between neighborhood active living potential and walking among middle-aged and older adults. A sample of 2,614 (61.1% women) persons aged 45 years or older and living in one of 112 census tracts in Montreal, Canada, were recruited between February and May of 2005 to participate in a 20-minute telephone survey. Data were linked to observational data on neighborhood active living potential in the 112 census tracts and analyzed through multilevel modeling. Greater density of destinations in the census tract was associated with greater likelihoods of walking for any reason at least 5 days per week for at least 30 minutes (odds ratio = 1.53, 95% confidence interval: 1.21, 1.94). Associations were attenuated but remained statistically significant after controlling for socioeconomic, health, lifestyle, and other physical activity characteristics. Sensitivity analyses showed that associations were robust across smaller and larger volumes of walking. No associations were found between dimensions of neighborhood active living potential and walking for recreational reasons. The authors conclude that a larger number and variety of neighborhood destinations in one's residential environment are associated with more walking and possibly more utilitarian walking among middle-aged or older adults.

This paper investigates the impact of pedestrian environments on walking behavior, and the related choice of travel path for transit riders. Activity logs from trip surveys combined with transit-route and land-use information are used to fit discrete-choice models of how riders choose among multiple paths to downtown destinations. The work illustrates (1) how the quality of pedestrian environments along transit egress paths affects transfers inside a transit system, and (2) how the impedance of transferring affects egress walking path choices. The use of GIS techniques for path-based spatial analysis is key to understanding the impact of pedestrian environments on walking behavior at the street level. The results show that desirable pedestrian environments encourage transit riders to choose paths that are 'friendlier', even if they involve more walking after leaving transit. Policy implications for land-use planning and transit service planning are discussed.

Purpose. Test for a causal relationship between neighborhood design. and physical activity within the neighborhood by controlling for self-selection. Design. Cross-sectional and quasi-longitudinal analyses of residents of selected neighborhoods. Setting. Eight Northern California neighborhoods. Subjects. Random sample of 1682 adults stratified by movers (moved within 1 year) and nonmovers (moved > 1 year ago) responding to self-administered mail surveys (24.7% response rate). Measures. Self-reported number of days in last 7 days of moderate to vigorous physical activity somewhere in the neighborhood and self-reported change in physical activity in the neighborhood from prior to moving (for movers) or from 1 year ago (for nonmovers). Analysis. Zero-inflated Poisson regression for cross-sectional analysis (n = 1497); ordered, probit model for quasi-longitudinal analysis (n = 1352). Results. After we controlled for physical activity attitudes and neighborhood preferences, selected neighborhood design characteristics were associated with physical activity within the neighborhood and changes in selected neighborhood design characteristics were associated with changes in physical activity within the neighborhood. Conclusions. Both cross-sectional and quasi-longitudinal analyses provided evidence of a causal impact of neighborhood design. Improving physical activity options, aesthetic qualities, and social environment may increase physical activity. Critical limitations included self-report measures of physical activity, lack of measures of duration and intensity of neighborhood physical activity, lack of measures of total physical activity, and limited measures of preferences related to physical activity.

Objective: To examine UK country and English regional differences in childhood overweight (including obesity) at 3 years and determine whether any differences persist after adjustment for individual risk factors. Design: Nationally representative prospective study. Setting: England, Wales, Scotland and Northern Ireland. Participants: 13 194 singleton children from the UK Millennium Cohort Study with height and weight data at age 3 years. Main outcome measure: Overweight (including obesity) was defined according to the International Obesity TaskForce cut-offs for body mass index, which are age and sex specific. Results: At 3 years of age, 23% (3102) of children were overweight or obese. In univariable analyses, children from Northern Ireland (odds ratio 1.30, 95% confidence interval 1.14 to 1.48) and Wales (1.26, 1.11 to 1.44) were more likely to be overweight than children from England. There were no differences in overweight between children from Scotland and England. Within England, children from the East (0.71, 0.57 to 0.88) and South East regions (0.82, 0.68 to 0.99) were less likely to be overweight than children from London. There were no differences in overweight between children from other English regions and children from London. These differences were maintained after adjustment for individual socio-demographic characteristics and other risk factors for overweight. Conclusions: UK country and English regional differences in early childhood overweight are independent of individual risk factors. This suggests a role for policies to support environmental changes that remove barriers to physical activity or healthy eating in young children.

Purpose. This study examined associations of environmental variables with obesity prevalence and individual body mass index (BMI) among impoverished residents of public housing developments. Design. Cross-sectional data were drawn from two studies in the same Midwestern metropolitan area of participants within neighborhoods. Setting. Pathways to Health interviewed housing development residents and Understanding Neighborhood Determinants of Obesity assessed built environment factors in the surrounding neighborhoods (i.e., 800-m radius from center of housing development). Subjects. Four hundred twenty-one residents participated (mean age = 43.8 years; 72.0% women, 59.6% high school degree, 79.6% African-American). Fifty-five physical activity resources were identified and assessed. Measures. Demographics and measured weights and heights were obtained for participants. The Physical Activity Resource Assessment measured the type, accessibility, features, amenities, qualities, and incivilities of neighborhood physical activity resources. Neighborhood street connectivity was also measured. Results. Average age-adjusted BMI was 31.4 (SD = 1.3), with 45% of residents obese. High negative correlations were found between BMI and street connectivity (p =.05) and between obesity prevalence and resource accessibility (p =.09), number of amenities (p =.04), and amenity quality (p =.04). Higher resource accessibility, feature quality, number of amenities, and fewer incivilities per resource accounted for 71 % of obesity variance (p

M. Hillsdon, D. A. Lawlor, S. Ebrahim and J. N. Morris. (2008). Physical activity in older women: associations with area deprivation and with socioeconomic position over the life course: observations in the British Women's Heart and Health Study. Journal Of Epidemiology And Community Health. 62, 344-350.

Objective: To assess the association between residential area-level deprivation, individual life-course socioeconomic position and adult levels of physical activity in older British women. Methods: A cross-sectional study of 4286 British women aged 60-79 years at baseline, who were randomly selected from general practitioner lists in 23 British towns between April 1999 and March 2001 (the British Women's Heart and Health Study). Results: All three of childhood socioeconomic position, adult socioeconomic position and area of residence (in adulthood) deprivation were independently (of each other and potential confounders) associated with physical activity. There was a cumulative effect of life-course socioeconomic position on physical activity, with the proportion who undertook no moderate or vigorous activity per week increasing linearly with each additional indicator of life-course socioeconomic position (p < 0.001 for linear trend). Conclusion: Adverse socioeconomic position across the life-course is associated with an increased cumulative risk of low physical activity in older women. Reducing socioeconomic inequalities across the life course would thus be expected to improve levels of physical activity and the associated health benefits in later life.

Introduction: Growing evidence suggests the built environment impacts obesity within urban areas; however, little research has investigated these relationships across levels of urbanisation in diverse and representative populations. This study aimed to determine whether personal and neighbourhood barriers differ by the level of urbanisation and the relative importance of personal barriers, neighbourhood barriers and land-use development patterns measured by a county-level sprawl index. Methods: Population-based, cross-sectional telephone survey data were collected on 1818 United States adults of diverse ethnicity and income level. Primary analyses were stratified by the level of urbanisation at the county level (large metropolitan, small metropolitan, non-metro, rural). Associations between obesity and neighbourhood and personal barriers were estimated with logistic regression, controlling for demographic variables. Within metropolitan areas, the association between body mass index (BMI) and county-level sprawl was estimated using hierarchical linear modelling, controlling for individual-level neighbourhood and personal barriers and demographic variables and then assessing cross-level interaction. Results: The prevalence of neighbourhood, but not personal, barriers differed widely across levels of urbanisation. Specific neighbourhood (eg traffic, unattended dogs) and personal (eg time, injury) barriers differentially correlated with obesity across strata. The impact of sprawl on BMI (B = -0.005) was consistent with previous findings; standardised coefficients indicate that personal (beta = 0.10) and neighbourhood (beta = 0.05) barriers had a stronger association than sprawl (beta = 20.02). Furthermore, the effect of sprawl on BMI increased by -0.006 with each additional personal barrier. Conclusions: Future intervention planning and policy development should consider that personal barriers and built environment characteristics may interact with each other and influence obesity differently across urbanisation levels.

A. Kaczynski, L. Potwarka and B. Saelens. (2008). Association of park size, distance, and features with physical activity in

neighborhood parks. Am J Public Health. 98, 1451-1456.

OBJECTIVES: We studied whether park size, number of features in the park, and

Background: The purpose of this study was to review reported associations between parks and recreation settings (PRSs) as features of the built environment and various functions and intensities of physical activity (PA). Methods: By searching 4 major databases for the years 1998 to 2005, 50 articles were uncovered that reported quantitative relationships between PRSs and PA. Results: Most articles showed some significant positive relationships between PRSs and PA. PRSs were more likely to be positively associated with PA for exercise or utilitarian functions than for recreational PA. Mixed results were observed for the associations between PRSs and both moderate and vigorous PA, but PRSs were commonly associated with walking. Conclusions: The studies indicated links between PRSs and PA and provided evidence for the contributions parks and recreation makes as part of the "health care" system within communities. Because of the ubiquity of PRSs and their potential contributions to active living, these relationships merit further exploration.

Objective: To assess the national prevalence of overweight and obesity, as well as some associated lifestyle behaviours, for the first time in Iran. Design and Settings: This population-based Study was performed in early 2005 as part of the World Health Organization (WHO) STEPwise approach to non-communicable diseases' risk factor surveillance. Dietary and physical activity habits were assessed by WHO questionnaires. Subjects: The study population comprised 89 532 subjects aged over 15 years living in the 28 provinces of Iran. Results: Overall, 50.4% (n = 45 113) of the participants were male and 64.6% (n = 57 866) were from the urban areas. The national estimates of overweight, obesity and morbid obesity were 28.6%, 10.8% and 3.4%, respectively. Body mass index (BMI) >= 25 kg m(-2) in men, women, urban residents and rural residents, were found in 37%, 48% 46.7% and 35.5%, respectively. Abdominal obesity was present in 43.4% of women, 9.7% of men, 28.5% of the urban residents and 23% of the rural residents. Overweight as well as generalised and abdominal obesity were more prevalent in the 45-64-year age group. Although there was no significant difference in frequency of consumption of the food groups in subjects with different BMI categories, various kinds of physical activities showed a steady decline with increasing BMI. Conclusions: The findings of the present study provide alarming evidence for health professionals and policy makers about the very high prevalence of generalised and abdominal obesity in Iran. The unhealthy lifestyle habits, notably sedentary lifestyles in our community, are the major contributing factors for this emerging public health problem.

Participating in leisure activities provides important benefits for all people. However, there is a substantial reduction of (green) leisure opportunities in cities, and the green spaces that are available often are poorly accessible. The purpose of this study is to analyze the diversity of participation in various types of leisure activities and to determine the relationship between leisure activity participation and characteristics of the residential environment depending on socio-demographic characteristics. Diary data from 803 respondents living in the Eindhoven region in the Netherlands were used. Four segments were identified that differ regarding their leisure activity participation, and a modest impact of green space accessibility was found.

The article assesses the impact of multilevel modeling of walking on personal, social, cultural or environmental behaviors. Advances in the application and understanding of this framework through the inclusion of previously ignored dimensions are discussed. State-of-the-art statistical method and computer technologies are applied to determine the complex relationship between multiple levels of impact and walking behavior. A research-practice agenda is recommended to establish better coordination of the simulation and scientific investigations.

This study examined whether features of the built environment and residents' perceptions of neighborhood walkability, safety, and social cohesion were associated with self-reported physical activity (PA) and community-based activity among a sample of 190 older adults (mean age 74) residing in 8 Denver neighborhoods. Neighborhood walking audits were conducted to assess walkability and social capital. In multilevel analyses, a few walkability variables including curb cuts, crosswalks, and density of retail predicted greater frequency of walking for errands (p C. E. Kirchner, E. G. Gerber and B. C. Smith. (2008). Designed to deter. Community barriers to physical activity for people with visual or motor impairments. Am J Prev Med. 34, 349-52.

BACKGROUND: People with disabilities are more likely to be obese, in poor health, and get less physical activity than the general population. However, research on community factors for physical activity has generally either excluded most people with disabilities, or overlooked relevant factors of community accessibility. This exploratory study investigated environmental factors affecting people with motor impairments and people with visual impairments in urban neighborhoods. METHODS: Quantitative and qualitative methods were used with a nonrandom sample (n=134) of users of four types of assistive mobility technologies: guide dogs, long canes, and motorized and manual wheelchairs. From July 2005 to August 2006, the sample participated in two telephone surveys. Between the surveys, a stratified random subsample (n =32) engaged in an ethnographic phase of observation and interviews. RESULTS: Most participants in all groups using assistive mobility technologies rated their neighborhoods as accessible, although they also reported many specific barriers. Users of assistive mobility technologies differed in the amount of reported physical activity and on specific barriers. Problems with sidewalk pavement and puddles/poor drainage were the most frequently mentioned environmental barriers, by 90% and 80%, respectively. Users of assistive mobility technologies were more similar on main strategies for dealing with barriers. All groups reported having to plan routes for outings, to alter planned routes, to go more slowly than planned, or to wait for a different time. CONCLUSIONS: Despite legislative requirements for accommodation, people with disabilities face barriers to physical activity, both in the built and social environments. Determined people with disabilities were able to overcome barriers, but required additional expenditure of resources to do so. Community design that can include people with disabilities requires detailed understanding of barriers specific both to types of impairments and to different types of assistive mobility technologies.

Background: Few studies have investigated the built environment and its association with health-especially excess adiposity-and physical activity in the immediate pre-Baby Boom/early-Baby Boom generations, soon to be the dominant demographic in the U.S. The purpose of this study was to examine this relationship. Methods: This study used a cross-sectional, multilevel design with neighborhoods as the primary sampling unit (PSU). Residents (N = 1221; aged 50-75) were recruited from 120 neighborhoods in Portland OR. The independent variables at the PSU level involved GIS-derived measures of land-use mix, distribution of fast-food outlets, street connectivity, access to public transportation, and green and open spaces. Dependent variables included resident-level measures of excess adiposity (BMI >= 25), three walking activities, and physical activity. Data were collected in 2006-2007 and analyzed in 2007. Results: Each unit (i.e., 10%) increase in land-use mix was associated with a 25% reduction in the prevalence of overweight/obesity. However, a 1-SD increase in the density of fast-food outlets was associated with a 7% increase in overweight/obesity. Higher mixed-use land was positively associated with all three types of walking activities and the meeting of physical activity recommendations. Neighborhoods with high street connectivity, high density of public transit stations, and green and open spaces were related in varying degrees to walking and the meeting of physical activity recommendations. The analyses adjusted for neighborhood- and resident-level sociodemographic characteristics. Conclusions: Findings suggest the need for public health and city planning officials to address modifiable neighborhood-level, built-environment characteristics to create more livable residential communities aimed at both addressing factors that may influence unhealthy eating and promoting active, healthy lifestyles in this rapidly growing population.

BACKGROUND: Environments conducive to walking may help people avoid sedentary lifestyles and associated diseases. Recent studies developed walkability models combining several built environment characteristics to optimally predict walking. Developing and testing such models with the same data could lead to overestimating one's ability to predict walking in an independent sample of the population. More accurate estimates of model fit can be obtained by splitting a single study population into training and validation sets (holdout approach) or through developing and evaluating models in different populations. We used these two approaches to test whether built environment characteristics near the home predict walking for exercise. Study participants lived in western Washington State and were adult members of a health maintenance organization. The physical activity data used in this study were collected by telephone interview and were selected for their relevance to cardiovascular disease. In order to limit confounding by prior health conditions, the sample was restricted to participants in good self-reported health and without a documented history of cardiovascular disease. RESULTS: For 1,608 participants meeting the inclusion criteria, the mean age was 64 years, 90 percent were white, 37 percent had a college degree, and 62 percent of participants reported that they walked for exercise. Single built environment characteristics, such as residential density or connectivity, did not significantly predict walking for exercise. Regression models using multiple built environment characteristics to predict walking were not successful at predicting walking for exercise in an independent population sample. In the validation set, none of the logistic models had a C-statistic confidence interval excluding the null value of 0.5, and none of the linear models explained more than one percent of the variance in time spent walking for exercise. We did not detect significant differences in walking for exercise among census areas or postal codes, which were used as proxies for neighborhoods. CONCLUSION: None of the built environment characteristics significantly predicted walking for exercise, nor did combinations of these characteristics predict walking for exercise when tested using a holdout approach. These results reflect a lack of neighborhood-level variation in walking for exercise for the population studied.

Background: The aim of this study was to investigate whether physical activity (in general, and more specifically, walking and cycling during leisure time and for commuting purposes, sports and gardening) is an underlying mechanism in the relationship between the amount of green space in people's direct living environment and self-perceived health. To study this, we first investigated whether the amount of green space in the living environment is related to the level of physical activity. When an association between green space and physical activity was found, we analysed whether this could explain the relationship between green space and health. Methods: The study includes 4.899 Dutch people who were interviewed about physical activity, self-perceived health and demographic and socioeconomic background. The amount of green space within a one-kilometre and a three-kilometre radius around the postal code coordinates was calculated for each individual. Multivariate multilevel analyses and multilevel logistic regression analyses were performed at two levels and with controls for socio-demographic characteristics and urbanicity. Results: No relationship was found between the amount of green space in the living environment and whether or not people meet the Dutch public health recommendations for physical activity, sports and walking for commuting purposes. People with more green space in their living environment walked and cycled less often and fewer minutes during leisure time; people with more green space garden more often and spend more time on gardening. Furthermore, if people cycle for commuting purposes they spend more time on this if they live in a greener living environment. Whether or not people garden, the time spent on gardening and time spent on cycling for commuting purposes did not explain the relationship between green space and health. Conclusion: Our study indicates that the amount of green space in the living environment is scarcely related to the level of physical activity. Furthermore, the amount of physical activity undertaken in greener living environments does not explain the relationship between green space and health.

Background. The presence and mix of destinations is an important aspect of the built environment that may encourage or discourage physical activity. This study examined the association between the proximity and mix of neighbourhood destinations and physical activity. Methods. Secondary analysis was undertaken on physical activity data from Western Australian adults (n=1394). These data were linked with geographical information systems (GIs) data including the presence and the mix of destinations located within 400 and 1500 in from respondents' homes. Associations with walking for transport and recreation and vigorous physical activity were examined. Results. Access to post boxes, bus stops, convenience stores, newsagencies, shopping malls, and transit stations within 400 in (OR 1.63-5.00) and schools, transit stations, newsagencies, convenience stores and shopping malls within 1500 in (OR 1.75-2.38) was associated with participation in regular transport-related walking. A dose-response relationship between the mix of destinations and walking for transport was also found. Each additional destination within 400 and 1500 in resulted in an additional 12 and 11 min/fortnight spent walking for transport, respectively. Conclusion. Proximity and mix of destinations appears strongly associated with walking for transport, but not walking for recreation or vigorous activity. Increasing the diversity of destinations may contribute to adults doing more transport-related walking and achieving recommended levels of physical activity.

R. Miles. (2008). Neighborhood disorder, perceived safety, and readiness to encourage use of local playgrounds. American Journal Of Preventive Medicine. 34, 275-281.

Background: Knowledge of the association between the neighborhood physical environment and adults' readiness to encourage children's use of local playgrounds, and the extent to which perceived safety acts as a mediator, can inform efforts to increase children's physical activity. Methods: Data were obtained from seven European cities based on a cross-sectional household survey conducted between 2001 and 2002. The sample included 2123 household informants (from a total of 2782 households) with a median age of 48 years; 65% were women, 66% were married, and 33% had achieved a secondary education. Indicators of local neighborhood physical disorder (litter, graffiti, lack of greenery), traffic volume, and land use were directly observed by trained surveyors. Perceived safety, encouragement of playground use, and physical activity levels were assessed with self-reported measures. Analyses were conducted in 2007. Results: Respondents in neighborhoods showing signs of low or moderate physical disorder compared to high physical disorder had slightly over twice the odds of encouraging children to use local playgrounds (p < 0.01). The percentage of the effect of neighborhood physical disorder accounted for by perceived safety was between 15% and 20%. Neighborhood physical disorder was associated only, vith adults' occasional involvement in sports or exercise and only among women (p < 0.05); perceived safety was not significantly associated with physical activity for either men or women. Conclusions: Neighborhood physical environments and perceived safety influence adults' readiness to encourage children's physical activity and women's occasional involvement in sports or exercise. Health promotion strategies designed to upgrade the environments near where children live and to address parental safety concerns merit further exploration.

We compare walking and obesity rates in two African-American neighborhoods that are similar in urban form but different in level of neighborhood disadvantage. We find higher rates of utilitarian walking in the neighborhood with higher density and disadvantage and more destinations within walking distance. However levels of leisure walking and physical activity were not higher, and rates of obesity were not lower in the non-poor neighborhood with better maintenance, more sidewalks and recreational facilities. Different types of barriers to physical activity reported in the two neighborhoods and the high rates of overweight and obesity in both may explain the findings.

Numerous studies have found that suburban residents drive more and walk less than residents in traditional neighborhoods. What is less well understood is the extent to which the observed patterns of travel behavior can be attributed to the residential built environment itself, as opposed to the prior self-selection of residents into a built environment that is consistent with their predispositions toward certain travel modes and land use configurations. To date, most studies addressing this attitudinal self-selection issue fall into seven categories: direct questioning, statistical control, instrumental variables models, sample selection models, joint discrete choice models, structural equations models, and longitudinal designs. This paper reviews and evaluates these alternative approaches with respect to this particular application (a companion paper focuses on the empirical findings of 28 studies using these approaches). We identify some advantages and disadvantages of each approach, and note the difficulties in actually quantifying the absolute and/or relative extent of the true influence of the built environment on travel behavior. Although time and resource limitations are recognized, we recommend usage of longitudinal structural equations modeling with control groups, a design which is strong with respect to all causality requisites.

BACKGROUND: Differences in availability of recreational resources may contribute to racial and socioeconomic status (SES) disparities in physical activity. Variations in the location and density of recreational resources were examined by SES and racial composition of neighborhoods. METHODS: Densities of resources available in recreational facilities and parks were estimated for census tracts between April 2003 and June 2004 in North Carolina, New York, and Maryland using kernel estimation. The probability of not having a facility or park was modeled by tract racial composition and SES, adjusting for population and area, using binomial regression in 2006. Mean densities of tract resources were modeled by SES and racial composition using linear regression. RESULTS: Minority neighborhoods were significantly more likely than white neighborhoods not to have recreational facilities (relative probability [RP]=3.27 [95% CI=2.11-5.07] and 8.60 [95% CI=4.48-16.51], for black and Hispanic neighborhoods, respectively). Low-income neighborhoods were 4.5 times more likely to not have facilities than high-income areas (95% CI=2.87-7.12). Parks were more equitably distributed. Most resources located in recreational facilities required a fee and were less dense in minority and low-income areas. Those located inside parks were usually free to use, sports-related, and denser in poor and minority neighborhoods. CONCLUSIONS: Recreational facilities and the resources they offer are not equitably distributed. The presence of parks in poor and minority areas suggest that improving the types and quality of resources in parks could be an important strategy to increase physical activity and reduce racial/ethnic and socioeconomic disparities.

Physical inactivity is a major health problem in the United States, particularly in elderly and disabled populations. Little research exists examining the relationships between aspects of the built environment and physical activity in older adults and individuals with multiple sclerosis (MS). We adopted a social cognitive perspective to examine the independent roles of perceptions of the environmental, self-efficacy and functional limitations in understanding physical activity levels among elderly women and women with MS. Older women (n = 136) and women diagnosed with MS (n = 173) were recruited to participate in separate cross-sectional studies. Individuals completed a battery of questionnaires and wore an activity monitor for 7 days. All measures were issued and collected through the mail with the use of self-addressed, pre-paid envelopes. Initial correlational analyses indicated that self-efficacy, functional limitations and environmental perceptions were significantly related to physical activity. Among older women, self-efficacy, functional limitations and street connectivity demonstrated independent contributions to physical activity behavior. Only self-efficacy and functional limitations demonstrated significant associations among women with MS. The prospective contributions of the environment and individual factors to changes in physical activity need to be determined.

Background: Perceptions of one's environment and functional status have been linked to physical activity in older adults. However, little is known about these associations over time, and even less about the possible mediators of this relationship. We examined the roles played by neighborhood satisfaction, functional limitations, self-efficacy, and physical activity in a sample of older women over a 6-month period. Methods: Participants (N = 137, M age = 69.6 years) completed measures of neighborhood satisfaction, functional limitations, self-efficacy, and physical activity at baseline and again 6 months later. Results: Analyses indicated that changes in neighborhood satisfaction and functional limitations had direct effects on residual changes in self-efficacy, and changes in self-efficacy were associated with changes in physical activity at 6 months. Conclusion: Our findings support a social cognitive model of physical activity in which neighborhood satisfaction and functional status effects on physical activity are in part mediated by intermediate individual outcomes such as self-efficacy. Additionally, these findings lend support to the position that individual perceptions of both the environment and functional status can have prospective effects on self-efficacy cognitions and ultimately, physical activity behavior.

This study investigated associations between neighborhood physical and social environments and body mass index in 2,865 participants of the Multi-Ethnic Study of Atherosclerosis (MESA) aged 45-84 years and residing in Maryland, New York, and North Carolina. Neighborhood (census tract) environments were measured in non-MESA participants residing in MESA neighborhoods (2000-2002). The neighborhood physical environment score combined measures of a better walking environment and greater availability of healthy foods. The neighborhood social environment score combined measures of greater aesthetic quality, safety, and social cohesion and less violent crime. Marginal maximum likelihood was used to estimate associations between neighborhood environments and body mass index (kg/m(2)) before and after adjustment for individual-level covariates. MESA residents of neighborhoods with better physical environments had lower body mass index (mean difference per standard deviation higher neighborhood measure = -2.38 (95% confidence interval (CI): -3.38, -1.38) kg/m(2) for women and -1.20 (95% CI: -1.84, -0.57) kg/m(2) for men), independent of age, race/ethnicity, education, and income. Attenuation of these associations after adjustment for diet and physical activity suggests a mediating role of these behaviors. In men, the mean body mass index was higher in areas with better social environments (mean difference = 0.52 (95% CI: 0.07, 0.97) kg/m(2)). Improvement in the neighborhood physical environment should be considered for its contribution to reducing obesity.

M. Neovius and F. Rasmussen. (2008). Place of residence and obesity in 1,578,694 young Swedish men between 1969 and 2005. Obesity (Silver Spring). 16, 671-6.

OBJECTIVE: To compare prevalence of overweight and obesity in young adult men from rural areas with those from urban areas of Sweden over three decades. METHODS AND PROCEDURES: Eighty-two percent of the Swedish male population at military conscription age between 1969 and 2005 (n = 1,578,694; 18.3 +/- 0.4 years) was grouped by urban, semiurban, and rural place of residence. BMI was calculated from measured height and weight. Comparisons were made with and without adjustments for parental education, socioeconomic position (SEP), and intelligence quotient (IQ). RESULTS: During the study period, the prevalence of obesity more than quintupled from 0.9-5.1%, while overweight tripled from 7.1-20.5% (P < 0.0001). An urban-rural gradient was observed within all socioeconomic and education strata. After adjustment for SEP, IQ, parental education level, and testing year, the odds ratios (ORs) were 1.28 (1.23-1.34) and 1.20 (1.18-1.22) for obesity and overweight, respectively, in a rural compared to an urban area. The corresponding ORs for semiurban place of residence were 1.16 (1.13-1.19) and 1.11 (1.10-1.12), respectively. Significant effect modification by time was seen, with evidence of an increasing gradient until the early 1990s (P < 0.001). DISCUSSION: A strong and persisting gradient of increasing overweight and obesity from urban to rural areas was observed that could not be explained by individual or family-related factors such as IQ, parental education level, or SEP. These results indicate the presence of strong environmental or contextual obesogenic factors affecting the energy balance of people in rural areas more negatively than those in urban communities.

Objective. To examine associations between household income, access to sports facilities and gyms, and physical activity in an English city. Method. A cross sectional geographical study was conducted in six neighbourhoods in the city of Norwich in August and September 2004. Participants were (n = 401) adults who received, completed, and returned questionnaires. Road distances to facilities were calculated using Geographical Information System. Results. For all facility types except gyms, mean income was lowest amongst those living farthest away. Compared to those with the lowest incomes, the most affluent participants lived on average just over 0.5 km closer to a facility of any type, 1 km closer to a sports facility but 900 m farther from a gym (all p < 0.001). In general, those living farther from facilities reported that they were less active although they did not tend to report a desire to exercise more. Conclusion. People in low income households, who are more likely to adopt low levels of activity, are least well served by affordable facilities that would enable them to become more active. If the British Government is to meet targets for improving levels of physical activity, it may need to consider how market forces might be creating an inequitable distribution of facility provision.

Background: Past research has suggested that changes in culture explain the substantial weight gain seen in many immigrant groups with length of residence in the U. S. and across generations of residence in the U. S. However, it has been theorized that those settling in immigrant and co-ethnic neighborhoods may be buffered against this acculturative process and will be more likely to maintain home country dietary and physical activity patterns. To investigate this theory we incorporated measures of neighborhood immigrant composition into analyses of individual's body mass index (BMI) and generation of immigration and duration of residence in the U. S. Methods: Multilevel analyses were performed using objectively measured height and weight and survey data on diet and physical activity from a sample of 13,011 residents of New York City. Census data were used to calculate the proportion of foreign-born residents and extent of household linguistic isolation in a 1/2 mile radial buffer around the subject's home. Results: Foreign birth was associated with a significantly lower BMI (-1.09 BMI units, P < 0.001). This association was weakest among Asians (-0.66 BMI units, P = 0.08) and strongest among Black-Caribbeans (-1.41 BMI units, P = 0.07). After controlling for individual level variables, neighborhood proportion foreign-born was not associated with BMI, but increasing neighborhood linguistic isolation was inversely associated with BMI among Hispanics (-2.97 BMI units, P = 0.03). Furthermore among Hispanics, the association between foreign birth and BMI was stronger in low linguistic isolation neighborhoods (-1.36 BMI units, P < 0.0001) as compared to in high linguistic isolation levels (-0.42 BMI units, P = 0.79). Increasing duration of residence in the U. S. was significantly associated with higher BMI overall and among Hispanics. Conclusion: The analyses suggest that acculturation is associated with weight gain, and that neighborhood characteristics are only associated with BMI among Hispanics. However, we suggest that changes in body size currently interpreted as post-migration effects of acculturation to U. S. norms may in fact reflect changes in norms that are taking place internationally.

Background: Although a number of studies have tested ecologic models that postulate relationships among social networks, the built environment, and active living, few neighborhood-based studies have considered the role of crime and violence. This study investigates the degree to which individual-level demographic characteristics and neighborhood-level physical and social characteristics are associated with increased fear of crime. Methods: Data were analyzed in 2007 from a 2005 survey of 901 randomly selected individuals living in 55 neighborhoods in Washington DC. Multilevel ordered logit regression was used to examine associations between individual-level and neighborhood-level characteristics and how often fear of crime prevents a respondent from walking outdoors. Results: Age and female gender were associated with an increase in fear; the percentage of a resident's life spent in the same neighborhood was associated with a decrease in fear. Results of cross-level interactions showed that at the neighborhood level, women were more fearful than men in neighborhoods without violence, but that the difference in fear between men and women shrinks as neighborhood violence increases. Collective efficacy was found to increase fear among black respondents and had no effect on fear among nonblack respondents. Conclusions: If the study of neighborhoods and active living is to progress and contribute to both etiologic understanding and policy formation, it is essential that theoretical and empirical models consider the impact of violence and fear on walking. Efforts to increase active living in urban neighborhoods that do not account for the impact of crime and fear may fall short of their intended outcomes.

The article examines the evidence on the built environment correlates with walking. It cites that there has been an increase in empirical investigation into the relations between built environment and physical activity. According to the article, practitioners need an understanding of the specific characteristics of the built environment that correlate most strongly with walking to create places that facilitate and encourage walking. Moreover, research on the characteristics of the built environment with walking is discussed.

Objectives. The aim of the present study was to determine whether the relation of perceived neighbourhood attributes to reported Physical Activity (PA) levels in Azorean adults varied by gender and body mass index (BMI). Methods. 7330 adult participants (4104 women), aged 38.1 +/- 93 years, from the 2004 Azorean Physical Activity and Health Study. They answered the Environmental Module and the short version of the International Physical Activity Questionnaire (IPAQ). Height and weight were self-reported. Results. After adjustments for age, BMI, education level and island of residence, the dimension Infrastructures, Access to destinations, Social environment and Aesthetics was positively associated with moderate PA level and Health-Enhancing Physical Activity (HEPA) level, only in women. When participants were categorized by BMI status, the same dimension was a significant predictor for moderate PA level in normal weight men and women, and for HEPA level only in overweight/obese women, after controlling for age, education level and island of residence. Conclusions. The dimension Infrastructures, Access to destinations, Social environment and Aesthetics was predictors of higher PA levels in Azorean adults. Targeted programs for Azoreans to increase PA levels should consider that this set of environmental features seem to act synergistically and are positively associated with PA.

Despite widespread knowledge that physical activity is a valuable mechanism for preventing many lifestyle diseases, data from the 2001 Behavioral Risk Factor Surveillance System indicate that less than half of the US population met activity recommendations established by the Centers for Disease Control and Prevention. To increase physical activity levels, community officials around the United States have identified public parks as a convenient, low-cost resource to enable active living. However, the amenities of the built park environment that best facilitate active park visits are unknown. The current article describes the relationship of micro-level environmental components and park visitors' physical activity. Using the System for Observing Play and Recreation in Communities, park visitation patterns are documented and described according to user demographics. Broadly, visitors who were observed in park environments, which contained playgrounds, sport courts, and paths, were significantly more active than visitors in settings without these features. Furthermore, six types of built features were able to explain 58% of the variance in observed activity intensity among park visitors. Findings suggest that built features that support physical activity across the life span (paths and courts in particular) may be considered by community leaders seeking relatively low-cost mechanisms to promote physical activity among residents.

Objective and Participants: At 2 Arizona State University (ASU) campuses, the authors measured student activity and distance walked on campus, as well as student-reported walkability around the student union. Methods: Students from ASU-Polytechnic (n = 20, 33% male) and ASU-Tempe (n = 20, 60% male) recorded distance walked on campus and wore physical activity monitors for 5 days. Results: Polytechnic students spent an average of 36.9 minutes in moderate-to-vigorous physical activity each week; Tempe students spent 69.5 minutes (p

BACKGROUND: People with physical disabilities are more likely to be sedentary than the general population, possibly because they have an accrued sensitivity to environmental features. OBJECTIVES: This paper describes the relationship between neighborhood-level active living buoys and the active living practices of adults with physical disabilities living in a large urban area. METHODS: A sample of 205 people with physical disabilities was recruited via a local rehabilitation center and its adapted fitness center. Telephone interviews were administered by senior occupational therapy students. The interview included a modified version of the Physical Activity and Disability Survey, a validated instrument that includes questions on physical activity, active transportation, and other activities of daily living. Individuals were geocoded within their census tract of residence (n=114) using their postal codes. Data on neighborhood active living potential were gleaned from systematic social observation. RESULTS: Multilevel logistic regression analyses showed that the association between the presence of environmental buoys and leisure activity was significant (OR=4.0, 95% CI=1.1-13.8) despite adjustments for individual difference variables while the association with active transportation became nonsignificant (OR=2.9, 95% CI=0.7-7.7) following adjustment for these variables. CONCLUSIONS: People with physical disabilities who live in neighborhoods with more environmental buoys are more likely to report involvement in leisure-time physical activity.
T. Sugiyama, E. Leslie, B. Giles-Corti and N. Owen. (2008). Associations of neighbourhood greenness with physical and mental health: do walking, social coherence and local social interaction explain the relationships? Journal Of Epidemiology And Community Health. 62,

Background: Studies have shown associations between health indices and access to "green'' environments but the underlying mechanisms of this association are not clear. Objectives: To examine associations of perceived neighbourhood "greenness'' with perceived physical and mental health and to investigate whether walking and social factors account for the relationships. Methods: A mailed survey collected the following data from adults (n = 1895) in Adelaide, Australia: physical and mental health scores (12- item short-form health survey); perceived neighbourhood greenness; walking for recreation and for transport; social coherence; local social interaction and sociodemographic variables. Results: After adjusting for sociodemographic variables, those who perceived their neighbourhood as highly green had 1.37 and 1.60 times higher odds of better physical and mental health, respectively, compared with those who perceived the lowest greenness. Perceived greenness was also correlated with recreational walking and social factors. When walking for recreation and social factors were added to the regression models, recreational walking was a significant predictor of physical health; however, the association between greenness and physical health became non-significant. Recreational walking and social coherence were associated with mental health and the relationship between greenness and mental health remained significant. Conclusions: Perceived neighbourhood greenness was more strongly associated with mental health than it was with physical health. Recreational walking seemed to explain the link between greenness and physical health, whereas the relationship between greenness and mental health was only partly accounted for by recreational walking and social coherence. The restorative effects of natural environments may be involved in the residual association of this latter relationship.

Several studies have found significant relationships between environmental characteristics (e.g., number of destinations, aesthetics) and physical activity. While a few of these studies verified that the physical activities assessed were performed in the environments examined, none have done this in an urban, neighborhood setting. This information will help efforts to inform policy decisions regarding the design of more "physically active" communities. Fourteen environmental characteristics of 60, 305-m-long segments, located in an urban, residential setting, were directly measured using standardized procedures. The number of individuals walking, jogging, and biking in the segments was assessed using an observation technique. The segments were heterogeneous with regards to several of the environmental characteristics. A total of 473 individuals were seen walking, bicycling, or jogging in the segments during 3,600 min of observation (60 min/segment). Of the 473 seen, 315 were walking, 116 bicycling, and 42 jogging. A greater number of individuals were seen walking in segments with more traffic, sidewalk defects, graffiti, and litter and less desirable property aesthetics. Only one environmental characteristic was associated with bicycling and none were significantly related with jogging. This study provides further evidence that environmental characteristics and walking are related. It also adds new information regarding the importance of scale (e.g., micro, macro) and how some environmental characteristics of urban, residential sidewalks and streets relate to physical activity.

BACKGROUND: No studies have yet examined the associations of physical environmental attributes specifically with walking in adults with type 2 diabetes. PURPOSE: The purpose of this study was to examine associations of perceived community physical environmental attributes with walking for transport and for recreation among adults living with type 2 diabetes. METHODS: Participants were 771 adults with type 2 diabetes who completed a self-administered survey on perceived community physical environmental attributes and walking behaviors. RESULTS: Based on a criterion of a minimum of 120-min/week, some 29% were sufficiently active through walking for transport and 33% through walking for recreation. Significantly higher proportions of those actively walking for transport and for recreation had shops or places to buy things close by (67.8% and 60.9%); lived within a 15-min walk to a transit stop (70.6% and 71.0%); did not have dead-end streets close by (77.7% and 79.8%); reported interesting things to look at (84.8% and 84.4%); and lived close to low-cost recreation facilities (81.3% and 78.8%). In addition, those actively walking for transport reported living in a community with intersections close to each other (75.6%) and with sidewalks on their streets (88.1%). When these variables were entered simultaneously into logistic regression models, living close by to shops was positively related to walking for transport (OR = 1.92, 99% CI = 1.11-3.32). CONCLUSIONS: Consistent with findings from studies of healthy adult populations, positive perceptions of community environmental attributes are associated with walking for transport among adults with type 2 diabetes. The now-strong public health case for environmental innovations to promote more walking for transport is further reinforced by the potential to benefit those living with diabetes.

M. J. van der Meer. (2008). The sociospatial diversity in the leisure activities of older people in the Netherlands. Journal Of Aging Studies. 22, 1-12.

Leisure activities afford an important way for old people to continue to take part in society and have a positive effect on personal wellbeing. The types and number of leisure activities in which older people participate are highly diverse. This diversity is associated not only with personal characteristics, but also with those of the environment in which old people live. Using cross sectional data selected in 2002-2003, differences are presented between regions, cities and villages, and between prosperous and deprived neighbourhoods. The characteristics of the region and of the urban or rural environment show a clear relationship wit the intrinsic orientation in leisure. The diversity is smallest among older adults who live in deprived neighbourhoods and among the very old. They take part in fewer activities (contraction), which leads to a more similar activity pattern in and around the home (convergence).

Objective: To assess physical activity (PA) behaviours of adults in rural Australia. Design and setting: Three cross-sectional surveys in the Greater Green Triangle area covering the south-east of South Australia (Limestone Coast), and south-west (Corangamite Shire) and north-west (Wimmera) of Victoria during 2004-2006. Participants: A total of 1546 persons, aged 2574 years, randomly selected from the electoral roll. Main outcome measures: Overall PA, leisure-time PA, occupational PA, active commuting and moderate-to-vigorous PA. Results: Approximately 80% of participants, more women than men, engaged in 30 minutes or more of daily PA. Only 30% (95% CI 26.3, 33.0) of men and 21% (95% CI 18.3, 23.9) of women did moderate-to-vigorous PA for at least 20-30 minutes four or more times a week. In leisure time, most participants were moderately active; almost one-fifth were inactive and another fifth highly active. Two-thirds of men engaged in high-level occupational PA, compared with one-sixth of women. Only 30% of participants actively commuted to work. There was a tendency for a positive association between income level and leisure-time PA. Conclusions: One-fifth of adults in rural Australia were inactive. While there was a high prevalence of participants who engaged in daily PA, few did so at moderate-to-vigorous intensity to achieve health benefits. As occupational PA is difficult to change, improvements in levels of PA are more likely during leisure-time and for some people by engaging in commuting PA.

Background: Few studies have employed longitudinal data to examine associations between the physical environment and walking. Methods: Using cross-sectional (n=70) and longitudinal (n=32) data (collected 2003-2006), associations of neighborhood design and demographics with walking were examined. Participants were low-income, primarily African-American women in the southeastern U.S. Through a natural experiment, some women relocated to neo-traditional communities (experimental group) and others moved to conventional suburban neighborhoods (control group). Results: Post-move cross-sectional comparisons indicated that women in neo-traditional neighborhoods did not, on average, walk more than women in suburban neighborhoods. Race and household size were significant predictors of physical activity. Additionally, using longitudinal data, this study controlled for the effects of pre-move walking and demographics. Analyses examined the effects of environmental factors (e.g., density, land-use mix, street-network patterns) on post-move walking. Women who moved to places with fewer culs-de-sac, on average, walked more. Unexpectedly, increases in land-use mix were associated with less walking. Conclusions: Results suggest that neo-traditional neighborhood features alone (e.g., sidewalks, front porches, small set-back distances) may not be enough to affect walking; however, changes in street patterns may play a role.

Objective: The aim of the present paper was to give insight into the practical consequences of using either single-level or multilevel regression analyses on data from research on environmental determinants of physical activity. Methods: For this purpose, results from single-level and multilevel regression analyses on comparable attributes of the environment were compared using a combination of individual and aggregated data, merged at the neighbourhood level. Results: Using only individual level data, applying multilevel instead of single-level analyses did not substantially influence the results. However, ignoring the multilevel structure of our data by applying single-level in stead of multilevel analyses resulted in statistically significant associations for all the environmental attributes under study. Moreover, using information on environmental attributes at both the individual and the contextual level to adjust associations at one level for the other level showed that associated environmental attributes tend to be associated either at the individual or at the contextual level. Conclusions: These results stress the importance for reviews and meta-analyses of recording type of measurement and type of analytical strategy used and incorporating them in the review process. Using advanced multilevel designs will still only partly solve the methodological issues involved in studying environmental attributes associated with physical activity, but it will help in disentangling this complex relationship. Therefore, it is recommended that, whenever there is a presumably relevant grouping (context; eg neighbourhoods) in a study, a multilevel approach should at least be considered.

This paper describes the preliminary steps needed to begin a community physical activity intervention in a rural context, including forming a community coalition and assessing values, beliefs, and knowledge about physical activity. A random mail survey (N = 171) indicated relatively high activity rates, and perceived barriers consistent with the literature (time, program convenience, safety issues). Perceived benefits included improving/sustaining health and looking better/improving appearance. Five focus groups added additional barriers (e.g., physical isolation, lack of transportation). Residents were unaware of many existing services and indicated a desire for more walking trails, health-related activities, and low-cost exercise facilities. The discussion focuses on the importance of establishing a community coalition and implications for future program development and research.